<?=$this->load->view('include_header',null)?>
<style type="text/css">
form#form textarea {
    height: 50px;
    overflow: auto;
    padding: 5px;
    width: 410px;
}
</style>
	<div id="top-panel">
		<div id="panel">
			<ul>
				<li class="current"><a href="<?=site_url('archive/idcard/'.$id)?>" class="report"><?=(empty($id))?"录入新":"编辑"?>客户基本信息</a></li>
				<?php if(!empty($info->id)):?><li><a id="printInfo" class="folder_table">打印本页信息</a></li><?php endif;?>
			</ul>
		</div>
	</div>
	<div id="wrapper">
		<div id="content">
			<div id="box">
<!-- table begin -->
<form method="post" id="form"  enctype="multipart/form-data" action="<?=site_url('schengen/cn_ny_update/'.$cateid)?>">

	<h3>中华人民共和国纽约领馆申请表</h3>
    <table width="100%">
    <thead>
        <tr>
          <td colspan="4" align="right"><img src="<?= (@$info->avatar)?@$info->avatar:'images/avatar.gif'?>" width="150" height="150" /></td>
		  <td align="right">
		  上传照片<br />
		  <input type="file" name="userphoto" /><br />
		  (.gif|.jpg|.png文件,最大1M)<br />
		  <?php if (@$info->attachment):?><a href="<?= @$info->attachment?>" target="_blank">点击下载附件</a><?php endif; ?>
		  &nbsp;&nbsp;&nbsp;&nbsp;上传附件<br />
		  <input type="file" name="userfile" /><br />
		  (.pdf|.zip|.rar|.doc,最大2M)		  </td>
        </tr>
    </thead>
    <tfoot>
        <tr>
            <td colspan="5" align="right">			
			<input type="hidden" name="id" value="<?=$id?>" />
			<input id="button1" type="submit" value="提交信息" />
			<input id="button2" type="reset" value="重置" />			</td>
        </tr>
    </tfoot>

    <tbody>
        <tr class="odd">
            <td colspan="5"><strong>一、个人信息 Section 1：Personal information</strong></td>
        </tr>
        <tr class="even">
            <td>1.1英文姓名<br />
              Full name as shown on your passport</td>
            <td>姓Surname：
              <input type="text" name="surname" value="<?= @$info->surname?>" />
              <br />名Given name：
              <input type="text" name="firstname" value="<?= @$info->firstname?>" /></td>
            <td>&nbsp;</td>
            <td>1.2 性别<br />
              Sex</td>
            <td><input type="radio" name="sex" value="1" <?= (@$info->sex==1)?'checked':''?> />
              男 M
                <input type="radio" name="sex" value="2" <?= (@$info->sex==2)?'checked':''?> />
              女 F</td>
        </tr>
        <tr class="odd">
            <td>1.3 中文姓名（如有，请用汉字填写）<br />
              Name in Chinese character ( if applicable)</td>
            <td><input type="text" name="cn_name" value="<?= @$info->cn_name?>" /></td>
            <td>&nbsp;</td>
            <td>1.4 别名或曾用名<br />
              Other name or previous name（if applicable）</td>
            <td><input type="text" name="other_name" value="<?= @$info->other_name?>" /></td>
        </tr>
        <tr class="even">
            <td>1.5 用母语书写的名字<br />
              Name in native language</td>
            <td><input type="text" name="native_name" value="<?= @$info->native_name?>" /></td>
            <td>&nbsp;</td>
            <td>1.6 现有国籍<br />
              Current nationality</td>
            <td><input type="text" name="cur_nationality" value="<?= @$info->cur_nationality?>" /></td>
        </tr>
        <tr class="odd">
            <td>1.7 曾有国籍<br />
              Former nationality</td>
            <td><input type="text" name="ori_nationality" value="<?= @$info->ori_nationality?>" /></td>
            <td>&nbsp;</td>
            <td>1.8 同时具有的国籍<br />
              Concurrent nationality</td>
            <td><input type="text" name="con_nationality" value="<?= @$info->con_nationality?>" /></td>
        </tr>
        <tr class="even">
          <td>1.9 出生日期<br />
            Date of birth (yyyy-mm-dd)</td>
            <td nowrap="nowrap"><input type="text" name="birth" value="<?= @$info->birth?>" id="birth"/></td>
            <td>&nbsp;</td>
            <td>1.10 出生地点(国、省/市)<br />
              Place of birth (city,<br />
              province/state, country)</td>
            <td><input type="text" name="birth_place" value="<?= @$info->birth_place?>" /></td>
        </tr>
        <tr class="odd">
            <td>1.11 美国身份证号码<br />
            	U.S. ID card number</td>
            <td colspan="4"><input type="text" name="national_id" value="<?= @$info->national_id?>" /></td>
        </tr>
        <tr class="even">
            <td>1.12 婚姻状况<br />
              Marital status</td>
            <td colspan="4"><input type="radio" name="marital_status" value="1" <?= (@$info->marital_status==1)?'checked':''?>/>
              已婚 Married 
              <input type="radio" name="marital_status" value="2" <?= (@$info->marital_status==2)?'checked':''?>/>
              未婚 Never Married 
<input type="radio" name="marital_status" value="3" <?= (@$info->marital_status==3)?'checked':''?>/>
离婚 Divorced 
<input type="radio" name="marital_status" value="4" <?= (@$info->marital_status==4)?'checked':''?>/>
丧偶 Widowed 
<br />
<input type="radio" name="marital_status" value="5" <?= (@$info->marital_status==5)?'checked':''?>/>
其他（请说明）Other（Please specify）: &nbsp;&nbsp;&nbsp; <input type="text" name="marital_status_other" value="<?= @$info->marital_status_other?>" /></td>
        </tr>
        <tr class="odd">
            <td>1.13 当前职业(可选多项)<br />
              Current occupation(s)</td>
            <td colspan="4">
<input type="checkbox" name="occupation[]" value="1" <?= (in_array('1',@$info->occupation))?'checked="checked"':''?> />
商人Businessman 
<input type="checkbox" name="occupation[]" value="2" <?= (in_array('2',@$info->occupation))?'checked="checked"':''?>  />
政府官员 Government official 
<br />
<input type="checkbox" name="occupation[]" value="3" <?= (in_array('3',@$info->occupation))?'checked="checked"':''?>  />
公司职员Company employee 
<input type="checkbox" name="occupation[]" value="4" <?= (in_array('4',@$info->occupation))?'checked="checked"':''?>  />
新闻从业人员Staff of media 
<br />
<input type="checkbox" name="occupation[]" value="5" <?= (in_array('5',@$info->occupation))?'checked="checked"':''?>  />
教师 Teacher 
<input type="checkbox" name="occupation[]" value="6" <?= (in_array('6',@$info->occupation))?'checked="checked"':''?>  />
宗教人士 Religious worker 
<br />
<input type="checkbox" name="occupation[]" value="7" <?= (in_array('7',@$info->occupation))?'checked="checked"':''?>  />
学生Student 
<input type="checkbox" name="occupation[]" value="8" <?= (in_array('8',@$info->occupation))?'checked="checked"':''?>  />
现役军人 Active duty military personnel
<br /> 
<input type="checkbox" name="occupation[]" value="9" <?= (in_array('9',@$info->occupation))?'checked="checked"':''?>  />
家庭主妇Housewife 
<input type="checkbox" name="occupation[]" value="10" <?= (in_array('10',@$info->occupation))?'checked="checked"':''?>  />
国会议员 Member of national parliament 
<br />
<input type="checkbox" name="occupation[]" value="11" <?= (in_array('11',@$info->occupation))?'checked="checked"':''?>  />
无业Unemployed
<input type="checkbox" name="occupation[]" value="12" <?= (in_array('12',@$info->occupation))?'checked="checked"':''?>  />
乘务人员 Crew member 
<br />
<input type="checkbox" name="occupation[]" value="13" <?= (in_array('13',@$info->occupation))?'checked="checked"':''?> />
退休 Retired<br />
<input type="checkbox" name="occupation[]" value="14" <?= (in_array('14',@$info->occupation))?'checked="checked"':''?>  />
其他（请说明）Other（Please specify）: &nbsp;&nbsp;&nbsp;
<input type="text" name="occupation_other" value="<?= @$info->occupation_other?>" />
            </td>
        </tr>
        <tr class="even">
            <td>1.14 护照种类<br />
              Passport type</td>
            <td colspan="4"><input type="radio" name="travel_document_type" value="1" <?= (@$info->travel_document_type==1)?'checked':''?>/>
              外交护照 Diplomatic passport 
              <input type="radio" name="travel_document_type" value="2" <?= (@$info->travel_document_type==2)?'checked':''?>/>
              公务/官员护照Service/Official passport <br />
<input type="radio" name="travel_document_type" value="3" <?= (@$info->travel_document_type==3)?'checked':''?>/>
普通护照 Ordinary passport 
<input type="radio" name="travel_document_type" value="4" <?= (@$info->travel_document_type==4)?'checked':''?>/>
其他证件(请说明)Other (Please specify):&nbsp;
<input type="text" name="travel_document_type_other" value="<?= @$info->travel_document_type_other?>" /></td>
        </tr>
		        <tr class="odd">
            <td>1.15 护照号码<br />
              Passport number</td>
            <td><input name="travel_document_num" type="text" value="<?= @$info->travel_document_num?>" /></td>
			<td>&nbsp;</td>
			<td>1.16 护照签发日期<br />
			  Date of issue (yyyy-mm-dd)</td>
			<td><input name="travel_document_issue_date" type="text" value="<?= @$info->travel_document_issue_date?>" id="travel_document_issue_date" /></td>
        </tr>
        <tr class="even">
            <td>1.17 护照签发地点(省/市及国家)<br />
              Place of issue (city, province/state,<br />
              country)</td>
            <td><input type="text" name="travel_document_issue_place" value="<?= @$info->travel_document_issue_place?>" /></td>
            <td>&nbsp;</td>
            <td>1.18 护照失效日期<br />
              Expiry date (yyyy-mm-dd)</td>
            <td><input type="text" name="travel_document_valid_date" value="<?= @$info->travel_document_valid_date?>" id="travel_document_valid_date" /></td>
        </tr>		
        <tr class="odd">
            <td colspan="2">1.19 请选择取件日期(加急需额外缴费)<br />
              Please select pick-up day (Extra fee is charged for express pick-up)</td>
            <td colspan="3">
			<input type="radio" name="express" value="1" <?= (@$info->express==1)?'checked':''?>/>
			正常(第4-5 个工作日) Normal (the 4th or 5th working day)<br />
            <input type="radio" name="express" value="2" <?= (@$info->express==2)?'checked':''?>/>
            加急(第2-3 个工作日)Express (the 2nd or 3rd working day)</td>
        </tr>
        <tr class="even">
            <td colspan="5"><strong>二、赴华旅行信息 Section 2: Details of travel to China</strong></td>
        </tr>
        <tr class="odd">
            <td>2.1 赴中国主要事由（可选多项）<br/>
              Major purpose(s) of your visit(s) to China</td>
            <td colspan="4">
<input type="checkbox" name="purpose[]" value="1" <?= (in_array('1',@$info->purpose))?'checked="checked"':''?>/>
旅游 Tourism 
<input type="checkbox" name="purpose[]" value="2" <?= (in_array('2',@$info->purpose))?'checked="checked"':''?>/>
探亲 Family visit 
<input type="checkbox" name="purpose[]" value="3" <?= (in_array('3',@$info->purpose))?'checked="checked"':''?>/>
访友 Visiting friends 
<input type="checkbox" name="purpose[]" value="4" <?= (in_array('4',@$info->purpose))?'checked="checked"':''?>/>
商务 Business trip <br />
<input type="checkbox" name="purpose[]" value="5" <?= (in_array('5',@$info->purpose))?'checked="checked"':''?>/>
会议 Meeting 
<input type="checkbox" name="purpose[]" value="6" <?= (in_array('6',@$info->purpose))?'checked="checked"':''?>/>
过境 Transit 
<input type="checkbox" name="purpose[]" value="7" <?= (in_array('7',@$info->purpose))?'checked="checked"':''?>/>
任职就业 Employment 
<input type="checkbox" name="purpose[]" value="8" <?= (in_array('8',@$info->purpose))?'checked="checked"':''?>/>
记者常驻 As resident journalist <br />
<input type="checkbox" name="purpose[]" value="9" <?= (in_array('9',@$info->purpose))?'checked="checked"':''?>/>
记者临时采访 As journalist for temporary news coverage 
<input type="checkbox" name="purpose[]" value="10" <?= (in_array('10',@$info->purpose))?'checked="checked"':''?>/>
常驻外交、领事官员 As resident diplomat or consul<br /> 
<input type="checkbox" name="purpose[]" value="11" <?= (in_array('11',@$info->purpose))?'checked="checked"':''?>/>
商业演出 Commercial performance 
<input type="checkbox" name="purpose[]" value="12" <?= (in_array('12',@$info->purpose))?'checked="checked"':''?>/>
执行乘务 As crew member 
<input type="checkbox" name="purpose[]" value="13" <?= (in_array('13',@$info->purpose))?'checked="checked"':''?>/>
留学 Study 
<br />
<input type="checkbox" name="purpose[]" value="14" <?= (in_array('14',@$info->purpose))?'checked="checked"':''?>/>
官方访问 Official visit 
<input type="checkbox" name="purpose[]" value="15" <?= (in_array('15',@$info->purpose))?'checked="checked"':''?>/>
其他(请说明) Other (Please specify):&nbsp;
<input type="text" name="purpose_other" value="<?= @$info->purpose_other?>" /></td>
        </tr>
        <tr class="even">
            <td>2.2 计划入境次数<br />
              Intended number of entries</td>
            <td colspan="4">
			  <input type="radio" name="entry_num" value="1" <?= (@$info->entry_num==1)?'checked':''?>/>
              一次入境 (自申请日起3 个月内有效) One entry valid for 3 months from date of application<br />
              <input type="radio" name="entry_num" value="2" <?= (@$info->entry_num==2)?'checked':''?>/>
              二次入境 (自申请日起6 个月内有效) Two entries valid for 6 months from date of application<br />
              <input type="radio" name="entry_num" value="3" <?= (@$info->entry_num==3)?'checked':''?>/>
              半年多次入境（自申请日起6 个月内有效）Multiple entries valid for 6 months from date of application<br />
              <input type="radio" name="entry_num" value="4" <?= (@$info->entry_num==4)?'checked':''?>/>
              一年多次入境（自申请日起12 个月内有效）Multiple entries valid for 12 months from date of application<br />
              <input type="radio" name="entry_num" value="5" <?= (@$info->entry_num==5)?'checked':''?>/>
              其他(请说明) Other (Please specify):&nbsp;
              <input type="text" name="entry_num_other" value="<?= @$info->entry_num_other?>" /></td>
        </tr>

        <tr class="odd">
            <td>2.3 预计首次行程抵达中国的日期<br />
              Intended date of your first entry<br /> 
              (yyyy-mm-dd)</td>
            <td><input type="text" name="first_entry_date" value="<?= @$info->first_entry_date?>" id="first_entry_date" /></td>
            <td>&nbsp;</td>
            <td>2.4 预计行程中单次在华停留的最长天数<br />
              Your longest intended duration of stay</td>
            <td><input type="text" name="longest_stay" value="<?= @$info->longest_stay?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2">2.5 i) 请按时间顺序列明你访问中国的地点（省、市）<br />
              Please list cities and provinces to visit in China in a time sequence</td>
            <td colspan="3"><input name="visit_city" type="text" value="<?= @$info->visit_city?>" style="width:300px"/></td>
        </tr>
        <tr class="odd">
           <td colspan="5">2.5 ii) 请按时间顺序列明你在中国停留期间的住址及电话<br />
             Please list residence(s) and phone number(s) during your stay in China in a time sequence<br />
              1.详细地址Detailed address 
              <input name="residence1_address" type="text" value="<?= @$info->residence1_address?>"  style="width:300px" /> 
              &nbsp;&nbsp;电话Phone number 
				<input type="text" name="residence1_tel" value="<?= @$info->residence1_tel?>" />
<br />
2.详细地址Detailed address
<input name="residence2_address" type="text" value="<?= @$info->residence2_address?>"  style="width:300px" />
&nbsp;&nbsp;电话Phone number
<input type="text" name="residence2_tel" value="<?= @$info->residence2_tel?>" />
<br />
3.详细地址Detailed address
<input name="residence3_address" type="text" value="<?= @$info->residence3_address?>"  style="width:300px" />
&nbsp;&nbsp;电话Phone number
<input type="text" name="residence3_tel" value="<?= @$info->residence3_tel?>" />
<br />
4.详细地址Detailed address
<input name="residence4_address" type="text" value="<?= @$info->residence4_address?>"  style="width:300px" />
&nbsp;&nbsp;电话Phone number
<input type="text" name="residence4_tel" value="<?= @$info->residence4_tel?>" /></td>
        </tr>
        <tr class="even">
            <td>2.6 谁将承担往返中国及在中国的费用？<br />
              Who will pay for your trip to China?</td>
            <td colspan="4">
<input type="radio" name="who_pay" value="1" <?= (@$info->who_pay==1)?'checked':''?>/>
我本人 Myself 
<input type="radio" name="who_pay" value="2" <?= (@$info->who_pay==2)?'checked':''?>/>
邀请单位或个人 Inviter 
<input type="radio" name="who_pay" value="3" <?= (@$info->who_pay==3)?'checked':''?>/>
父母或监护人Parent(s) or guardian(s)<br />
<input type="radio" name="who_pay" value="4" <?= (@$info->who_pay==4)?'checked':''?>/>
其他(请说明) Other (Please specify):&nbsp;
<input type="text" name="who_pay_other" value="<?= @$info->who_pay_other?>" /></td>
        </tr>
        <tr class="odd">
            <td colspan="2">2.7 在华期间是否有医疗保险?如有，请填写保险公司名称及保险账号。Do you have medical insurance covering your visit in China? If “Yes”, please fill out the name of the medical insurance company and your account number.</td>
            <td colspan="3"><input type="radio" name="has_medical" value="1" <?= (@$info->has_medical==1)?'checked':''?>/>
              是 Yes 
                <input name="has_medical_detail" type="text" value="<?= @$info->has_medical_detail?>" style="width:300px" />
                <br />
                <input type="radio" name="has_medical" value="0" <?= (@$info->has_medical==0)?'checked':''?>/>
否 No</td>
        </tr>
        <tr class="even">
            <td>2.8 在华邀请/联系单位名称、地址及电话<br />
              Name, address and phone number of your<br />
              inviter or contact unit in China</td>
            <td colspan="4"><label>
              <textarea name="inviter_detail"><?= @$info->inviter_detail?></textarea>
            </label></td>
        </tr>
        <tr class="odd">
            <td>2.9 在华亲友/联系人姓名、地址、电话<br />
              Name, address and phone number of your
              relative, friend or contact person in China</td>
            <td colspan="4"><label>
              <textarea name="friend_detail"><?= @$info->friend_detail?></textarea>
            </label></td>
        </tr>
        <tr class="even">
            <td colspan="5"><strong>三、家庭、工作或学校信息 Section 3: Information about your family, work or study</strong></td>
        </tr>
        <tr class="odd">
            <td>3.1目前家庭住址<br />
              Zip code Current home address</td>
            <td colspan="4">地址Address: 
              <input name="home_address" type="text" value="<?= @$info->home_address?>" style="width:500px"/><br>
              城市City
              :
              <input name="home_city" type="text" value="<?= @$info->home_city?>" style="width:100px"/> 
              &nbsp;&nbsp;省/州Province/State: 
              <input name="home_province" type="text" value="<?= @$info->home_province?>" style="width:100px"/>
              &nbsp;&nbsp;邮编Zip code: 
              <input name="home_zip" type="text" value="<?= @$info->home_zip?>" style="width:50px"/></td>
        </tr>
        <tr class="even">
            <td>3.2 家庭电话<br />
              Home phone number</td>
            <td><input type="text" name="home_tel" value="<?= @$info->home_tel?>"/></td>
            <td>&nbsp;</td>
            <td>3.3 手机号码<br />
              Mobile phone</td>
            <td><input type="text" name="home_mobile" value="<?= @$info->home_mobile?>"/></td>
        </tr>
        <tr class="odd">
            <td>3.4 电子信箱
              <br />
              Email address</td>
            <td colspan="4"><input type="text" name="email" value="<?= @$info->email?>" id="email"/></td>
        </tr>
        <tr class="even">
            <td>3.5 工作单位或学校名称、电话、地址<br />
              Name, phone number and address of <br />
              your current employer or school</td>
			 <td colspan="4">名称Name <input name="com_name" type="text" value="<?= @$info->com_name?>" style="width:500px"/>
		      <br />
		      地址Address 
		      <input name="com_address" type="text" value="<?= @$info->com_address?>" style="width:500px"/> 
		      <br />电话Phone number 
		      <input type="text" name="com_tel" value="<?= @$info->com_tel?>" />
		      <br />
		      城市City 
		      <input type="text" name="com_city" value="<?= @$info->com_city?>" style="width:100px" />
&nbsp;&nbsp;省/州Province/State 
<input type="text" name="com_province" value="<?= @$info->com_province?>" style="width:100px" />
&nbsp;&nbsp;
邮编Zip code 
<input type="text" name="com_zip" value="<?= @$info->com_zip?>" style="width:50px" /></td>
        </tr>
        <tr class="odd">
            <td colspan="5">3.6 主要家庭成员Major family members<br />
姓名Name<input name="family1_name" type="text" value="<?= @$info->family1_name?>" style="width:100px"/>
&nbsp;&nbsp;国籍Nationality <input name="family1_nationality" type="text" value="<?= @$info->family1_nationality?>" style="width:100px"/>
&nbsp;&nbsp;职业Occupation <input name="family1_occupation" type="text" value="<?= @$info->family1_occupation?>" style="width:100px" />
&nbsp;&nbsp;关系Relationship<input name="family1_relate" type="text" value="<?= @$info->family1_relate?>" style="width:50px" />
<br />
姓名Name<input name="family2_name" type="text" value="<?= @$info->family2_name?>" style="width:100px"/>
&nbsp;&nbsp;国籍Nationality <input name="family2_nationality" type="text" value="<?= @$info->family2_nationality?>" style="width:100px"/>
&nbsp;&nbsp;职业Occupation <input name="family2_occupation" type="text" value="<?= @$info->family2_occupation?>" style="width:100px" />
&nbsp;&nbsp;关系Relationship<input name="family2_relate" type="text" value="<?= @$info->family2_relate?>" style="width:50px" />
<br />
姓名Name<input name="family3_name" type="text" value="<?= @$info->family3_name?>" style="width:100px"/>
&nbsp;&nbsp;国籍Nationality <input name="family3_nationality" type="text" value="<?= @$info->family3_nationality?>" style="width:100px"/>
&nbsp;&nbsp;职业Occupation <input name="family3_occupation" type="text" value="<?= @$info->family3_occupation?>" style="width:100px" />
&nbsp;&nbsp;关系Relationship<input name="family3_relate" type="text" value="<?= @$info->family3_relate?>" style="width:50px" />
<br />
姓名Name<input name="family4_name" type="text" value="<?= @$info->family4_name?>" style="width:100px"/>
&nbsp;&nbsp;国籍Nationality <input name="family4_nationality" type="text" value="<?= @$info->family4_nationality?>" style="width:100px"/>
&nbsp;&nbsp;职业Occupation <input name="family4_occupation" type="text" value="<?= @$info->family4_occupation?>" style="width:100px" />
&nbsp;&nbsp;关系Relationship<input name="family4_relate" type="text" value="<?= @$info->family4_relate?>" style="width:50px" />
<br />
		</td>
        </tr>
        <tr class="even">
            <td>3.7 紧急情况联系人<br />
              Contact person in case of emergency</td>
			<td><input type="text" name="emergency_person" value="<?= @$info->emergency_person?>"/></td>
			<td>&nbsp;</td>
			<td>3.8 电话号码<br />
			  Contact person’s phone number</td>
			<td><input type="text" name="emergency_tel" value="<?= @$info->emergency_tel?>"/></td>
        </tr>
        <tr class="odd">
            <td colspan="5"><strong>四、其他情况 Section 4: Other information</strong></td>
        </tr>
        <tr class="even">
            <td colspan="2">4.1 是否曾持中国签证访问过中国？如果是，请说明最近一次访问中国的<br />
              时间、地点和事由<br />
			Have you ever visited China before? If “Yes”, please specify date, places and <br />
			purpose of the latest visit.</td>
            <td colspan="3"><input type="radio" name="is_q1" value="0" <?= (@$info->is_q1==0)?'checked':''?>/>
              否 No<br />
              <input type="radio" name="is_q1" value="1" <?= (@$info->is_q1==1)?'checked':''?>/>
              是 Yes 
              <input name="q1_detail" type="text" value="<?= @$info->q1_detail?>" style="width:300px"/></td>
        </tr>
        <tr class="odd">
            <td colspan="2">4.2 在过去的12 个月里是否访问过其他国家或地区？如果是，请说明访问<br />
              时间、地点和目的。<br />
			Have you ever visited other countries or territories in the past 12 months? If “yes”,<br /> 
			please specify date, name of countries or territories and purpose of the visits.</td>
            <td colspan="3"><input type="radio" name="is_q2" value="0" <?= (@$info->is_residence==0)?'checked':''?>/>
否 No<br />
<input type="radio" name="is_q2" value="1" <?= (@$info->is_q2==1)?'checked':''?>/>
是 Yes
<input name="q2_detail" type="text" value="<?= @$info->q2_detail?>" style="width:300px"/></td>
        </tr>
        <tr class="even">
            <td colspan="2">4.3 是否曾在中国超过签证或居留许可允许的期限停留？<br />
              Have you ever overstayed your visa or residence permit in China?</td>
            <td colspan="3"><input type="radio" name="is_q3" value="1" <?= (@$info->is_q3==1)?'checked':''?>/>
是 Yes<br />
<input type="radio" name="is_q3" value="0" <?= (@$info->is_q3==0)?'checked':''?>/>
否 No</td>
        </tr>
        <tr class="odd">
            <td colspan="2">4.4 是否曾经被拒绝颁发中国签证,或被拒绝进入中国？<br />
              Have you ever been refused a visa for China, or been refused entry into China?</td>
            <td colspan="3"><input type="radio" name="is_q4" value="1" <?= (@$info->is_q4==1)?'checked':''?>/>
是 Yes<br />
<input type="radio" name="is_q4" value="0" <?= (@$info->is_q4==0)?'checked':''?>/>
否 No</td>
        </tr>
		
		<tr class="even">
            <td colspan="2">4.5 是否在中国或其他国家有违法记录？<br />
              Do you have any criminal record in China or any other country?</td>
            <td colspan="3"><input type="radio" name="is_q5" value="1" <?= (@$info->is_q5==1)?'checked':''?>/>
是 Yes<br />
<input type="radio" name="is_q5" value="0" <?= (@$info->is_q5==0)?'checked':''?>/>
否 No</td>
        </tr>
		
		<tr class="odd">
            <td colspan="2">4.6 是否患有以下任何一种疾病? Are you suffering from any of the following diseases?<br />
              ①严重精神疾病Serious mental disorder<br />
              ②传染性肺结核病Infectious pulmonary tuberculosis<br />
              ③可能对公共卫生造成危害的其他传染病Other infectious disease of public health hazards</td>
            <td colspan="3"><input type="radio" name="is_q6" value="1" <?= (@$info->is_q6==1)?'checked':''?>/>
是 Yes<br />
<input type="radio" name="is_q6" value="0" <?= (@$info->is_q6==0)?'checked':''?>/>
否 No</td>
        </tr>
		
		<tr class="even">
            <td colspan="2">4.7 近30 日内是否前往过流行性疾病传染的国家或地区？<br />
              Did you visit countries or territories infected by infectious diseases in the past 30 days?</td>
            <td colspan="3"><input type="radio" name="is_q7" value="1" <?= (@$info->is_q7==1)?'checked':''?>/>
是 Yes<br />
<input type="radio" name="is_q7" value="0" <?= (@$info->is_q7==0)?'checked':''?>/>
否 No</td>
        </tr>
		
		<tr class="odd">
            <td colspan="2">4.8 如果对4.3 到4.7 的任何一个问题选择“是”，请在下面详细说明。<br/>
If you answered “Yes” to any of questions 4.3 to 4.7, please give details below.<br /></td>
           <td colspan="3"><textarea name="q_detail"><?= @$info->q_detail?></textarea></td>
        </tr>
		
		<tr class="even">
            <td colspan="5"><strong>五、有关声明 Section 5: Relevant declaration</strong></td>
        </tr>
		
		<tr class="odd">
            <td colspan="5">5.1 如申请工作签证或学习签证，或不在国籍国申请签证，或与护照偕行人同行，你还需填写签证附表(Form V.2011B)。Please also complete<br />
              the Supplementary Visa Application Form (Form V.2011B) if you are not a U.S. citizen, or if you are applying for work visa or student visa, or if you<br />
              will be accompanied by anyone who shares the same passport with you.</td>
        </tr>
		
		<tr class="even">
            <td colspan="2">5.2 如果有本表未涉及而需专门陈述的其他与签证申请相关的事项，<br />
              请在此或另纸详细说明。<br />
              Please use the space below or a separate sheet for<br />
              additional information / declaration / statement other than already provided in this application.<br /></td>
           <td colspan="3"><textarea name="addition_info"><?= @$info->addition_info?></textarea></td>
        </tr>
		
		<tr class="odd">
            <td colspan="5"><strong>六、签名Section 6: Signature</strong></td>
        </tr>
		
		<tr class="even">
            <td colspan="5">6.1 我已阅读并理解此表所有内容要求，并保证所填信息的真实准确。如有不实，我愿承担一切责任。I have read and understood all the<br />
              questions in this application. I declare that the information provided above is true and accurate. I shall take all responsibilities for any false information.</td>
        </tr>
		
		<tr class="odd">
            <td colspan="5">6.2 我理解，能否获得签证、获得何种签证、入境次数以及有效期、停留期等将由领事官员决定，任何不实、误导或填写不完整均可能导致<br />
              签证申请被拒绝或被拒绝进入中国。I understand that the decision on whether to issue a visa, validity/ type of visa, number of entries, and duration<br />
              of each stay will be decided by consular officers, and that any false, misleading or incomplete information may result in the refusal of a visa or denial of<br />
              entry into China.</td>
        </tr>
		
		<tr class="even">
            <td colspan="5">&nbsp;</td>
        </tr>
		
		<tr class="odd">
            <td colspan="5">注：未满 18 周岁申请人可由父母或监护人代签。Note: Parent or guardian may sign on behalf of an applicant aged under 18.</td>
        </tr>
		
		<tr class="even">
            <td colspan="5"><strong>七、他人代填申请表时填写以下内容 Section 7：If the application form is completed by another person on the applicant’s behalf, please fill out the following:</strong></td>
        </tr>
		
		<tr class="odd">
            <td>7.1 申请表代填人姓名<br />
              Name of the person completing<br />
              this form on the applicant’s behalf</td>
			<td><input type="text" name="behalf_name" value="<?= @$info->behalf_name?>"/></td>
			<td>&nbsp;</td>
			<td>7.2 与申请人关系<br />
			  Relationship to the<br />
			  applicant</td>
			<td><input type="text" name="behalf_relate" value="<?= @$info->behalf_relate?>"/></td>
        </tr>
		
		<tr class="even">
            <td>7.3 地址<br />
              Address</td>
			<td><input name="behalf_address" type="text" value="<?= @$info->behalf_address?>"/></td>
			<td>&nbsp;</td>
			<td>7.4 电话<br />
			  Phone number</td>
			<td><input type="text" name="behalf_tel" value="<?= @$info->behalf_tel?>"/></td>
        </tr>
		
		<tr class="odd">
           <td>7.5 所持身份证件种类<br />
             Type of ID document</td>
			<td><input type="text" name="behalf_type" value="<?= @$info->behalf_type?>"/></td>
			<td>&nbsp;</td>
			<td>7.6 证件号码<br />
			  Number of ID</td>
			<td><input type="text" name="behalf_id" value="<?= @$info->behalf_id?>"/></td>
        </tr>
		
		<tr class="even">
           <td colspan="5">7.7 声明 Declaration<br />
             我声明本人是根据申请人要求而协助填表，并证明申请人理解并确认表中所填写内容准确无误。<br />
             I declare that I have assisted in the completion of this form at the request of the applicant, and the applicant understands and confirms that the<br />
             information provided is true and correct.</td>
        </tr>
		
		<tr class="odd">
           <td colspan="5">&nbsp;</td>
        </tr>
    </tbody>
	</table>
<!-- table end -->
</form>

			</div>
		</div>
		
		<?=$this->load->view('include_sidebar',array('id'=>$id,'forms'=>$forms))?>
	</div>

<script type="text/javascript">
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	$("#form").validate({
		rules: {
			version:"required",
			surname:"required",
			firstname:"required",
			sex:"required",
			cur_nationality:"required",
			birth:"required",
			birth_place:"required",
			marital_status:"required",
			travel_document_type:"required",
			travel_document_num:"required",
			travel_document_issue_date:"required",
			travel_document_issue_place:"required",
			travel_document_valid_date:"required",
			express:"required",
			entry_num:"required",
			who_pay:"required",
			emergency_person:"required",
			emergency_tel:"required"
		}
	});
  
	$.datepicker.setDefaults(
		{
		dateFormat: 'yy-mm-dd',
		changeMonth: true,
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		showOn: "both",
		buttonImage: "images/calendar.gif",
		buttonImageOnly: true
		}
	);

	$("#birth").datepicker();
	$("#travel_document_issue_date").datepicker();
	$("#travel_document_valid_date").datepicker();
	$("#first_entry_date").datepicker();
	
	$("#email").autoMail();

	$("#printInfo").click(function(o) {
		var prints = [
			{rel_id: <?=$cateid?>, rec_id: <?=$id?>}
		]  ;
		
		var jdata = JSON.stringify(prints);
		//alert(jdata);
		$.post("<?=site_url('proxy/does/'.str_replace('==','',base64_encode('http://'.$_SERVER['SERVER_NAME'].':9090/javaprduct/servlet/test')))?>",{clients:jdata},function(msg){alert(msg)});
	});
	
	$("#printInfo").ajaxError(function(event,request, settings){
		//$(this).append("<li>出错页面:" + settings.url + "</li>");
		alert("无法访问"+ settings.url );
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});
</script>

<?=$this->load->view('include_footer',null)?>